Labour Flashcards
What is labour?
Onset of regular and painful contractions associated with cervical dilation and descent of presenting part
When does normal labour occur? What does this result in?
After 37 weeks and results in spontaneous vaginal delivery of baby within 24h of onset of regular spontaneous contractions.
What often precedes labour?
A ‘show’
Plug of cervical mucus and a little blood as the membranes strip from the os
What are signs of labour?
Regular and painful uterine contractions
A show - shedding of mucus plug
Rupture of membranes (not always)
Shortening and dilation of the cervix
What are the stages of labour?
- from the onset of true labour to when cervix is fully dilated: cervix dilates and head flexes further and descends into pelvis
- full dilation to delivery of the fetus
- from delivery of fetus to when the placenta and membranes have been completely delivered
Describe the latent phase of first stage of labour
Latent phase:
Painful, often irregular contractions
Cervix initially effaces (becomes shorter and softer) then dilates to 4cm
Describe the established phase of first stage of labour
Regular contraction with dilatation from 4cm
What is a satisfactory rate of cervical dilatation in the established phase?
0.5cm/h
How long does the first stage take?
8-18h in primp
5-12h in multip
What should you do during first stage of labour?
Check maternal BP and temperature 4 hourly
Pulse hourly
Assess the contractions every 30 minutes
- strength
- frequency (ideally 3-4 per 10 minutes, lasting up to 1 minute)
Note frequency of bladder emptying
Offer vaginal examination to assess the degree of cervical dilatation, position and station of the head (cm above/below ischial spines)
Degree of moulding and caput
Note state of liquor
Auscultate fealty heart rate eery 15 minutes
What is the passive stage in the second stage?
Complete cervical dilatation but no pushing
Seen in women with epidural where 1-2 hours of passive stage is recommended to reduce instrumental delivery rate.
What is active stage of second stage?
Maternal pushing uses abdominal muscles and the Valsava manoeuvre until the baby is born
What should you do in second stage?
Discourage supine maternal position Check BP and pulse hourly Check temperature 4 hourly Assess contraction half hourly Auscultate for 1 min after a contraction Offer vaginal examination hourly Record urination durgin 2nd stage
What is required if contractions wane in second stage?
Oxytocin augmentation
Describe the third stage of labour
Delivery of the placenta
As the uterus contracts to a <24 weeks size after baby is born, the placenta separates from the uterus through the spongy layer of the decider basalts
It then buckles and a small amount of retroplacental haemorrhage aids its removal
What are signs of placenta separation in stage three?
Cord lengthening
Rush of blood (retroplacental haemorrhage) PV
Uterus rises
Uterus contracts in the abdomen (felt with hand as globular mass)
Takes < 1 hour
What can be given to decrease third stage time and reduce incidence of PPH?
Syntometrine
Ergometrine maleate + oxytocin
As the anterior shoulder is born
CI in pre-eclampsia, sever HTN, severe liver or renal impairment and heart disease
- just give oxytocin
Describe the passage of the baby
1.
Head descends into pelvis
2.
Head rotates at the levels of the ischial spin so the occiput lies in the anterior part of pelvis
Head broaches vulval ring (crowning and the perineum stretches over head)
Head is born
Anterior shoulder is born
Shoulders rotate to lie in the AP diameter of the pelvic outlet
Head roatates externally to its direction at onset of labour
Downward and backward traction fo the head by the birth attendant aids delivery of the anterior shoulder
Birth fo the posterior shoulder is aided by lifting the head upwards while maintaining traction
